Liver Directed Therapies For Cancers That Have Spread to The Liver
by Dr. C.H. Weaver M.D. (08/2018)
Virtually and cancer can spread to the liver. Colon, breast, lung, and GI cancers are most common. Cancers that have spread to the liver are primary treated with the systemic therapy designed to treat the origin of a specific cancer. Additional liver directed therapies can be used to augment systemic treatment or for the management of cancers with 1 to 2 liver metastases and no other evidence of spread.1,2
When it’s possible to completely surgically remove liver metastases, surgery is the preferred treatment. Although surgery offers some patients the chance for a cure, a majority of patients with liver metastases are not candidates for surgery because of the size or location of their tumors or their general health. Many individuals with cancer involving the liver erroneously conclude that they have no treatment options other than systemic therapy. There are however several therapeutic options for the treatment of liver metastases, and others being developed in clinical trials.3
Some patients may become candidates for surgery if initial treatment with chemotherapy shrinks the tumors sufficiently. If the tumors continue to be impossible to remove surgically, other liver-directed therapies may be considered.4
The type of liver directed therapy used is determined by the size of the cancer, the number of metastases, and the location of the cancers within the liver. Patients need to understand that many advanced treatment options are only be available at cancer centers specializing in the treatment of colon cancer and patients should consider getting an opinion at one of these centers. For example:
- Radiofrequency ablation (use of heat to kill cancer cells).
- Cryotherapy (use of cold to kill cancer cells).
- Delivery of chemotherapy directly to the liver.
- SIR-Spheres Y-90 resin microspheres are a medical device used in an interventional radiology procedure known as selective internal radiation therapy (SIRT), or radioembolization, which targets high doses of radiation directly to liver tumors. The treatment consists of tens of millions of radioactive Y-90 coated resin particles, each no bigger in diameter than a human hair. SIR-Spheres Y-90 are injected into the hepatic artery, which is the main blood supply to the liver via a catheter inserted into the femoral artery through an incision in the groin. The Y-90 resin microspheres become lodged in the smaller blood vessels that surround cancer in the liver, where they deliver a high dose of radiation to the cancer, while sparing healthy liver tissue.3,4,5
- Many liver metastases can be effectively treated with surgery, but not all cancer clinics have the expertise to offer surgery as a treatment option. One analyses has demonstrated that surgery for liver metastases that can be resected has produced long-term overall survival of nearly 50% at five years and nearly 30% at 10 years.6
- Additional clinical trials have demonstrated that the addition of chemotherapy following surgery for liver metastases further improves treatment outcomes.7
- In some patients with inoperable liver metastases, an initial round of chemotherapy or neoadjuvant radiation therapy can be used to shrink the liver metastases enough so that surgery becomes possible.8
- Using minimally invasive techniques such as ablation, embolization, or radioembolization allows the delivery of radiation therapy or chemotherapy directly to the liver tumor(s).
Patients with cancer that has spread to the liver need to make sure they are evaluated at a cancer center that offers advanced liver directed treatment options. They should also consider the role of clinical trials.
- American Cancer Society. Colorectal Cancer Facts & Figures 2017-2019. Atlanta: American Cancer Society, 2017.
- **Cho M, Gong J and Fakih M.**The state of regional therapy in the management of metastatic colorectal cancer to the liver. Expert Review of Anticancer Therapy, 2016; 16(2): 229–245.
- Alsina J, Choti MA. Liver-directed therapies in colorectal cancer. Seminars in Oncology. 2011;38:651-567.
- van Hazel GA, Heinemann V, Sharma NK et al. SIRFLOX: Randomized Phase III trial comparing first-line mFOLFOX6 (plus or minus bevacizumab) plus selective internal radiation therapy in patients with metastatic colorectal cancer. Journal of Clinical Oncology. 2016; 34: 1723–1731.
- **Kennedy AS, Ball D, Cohen SJ et al.**Multicenter evaluation of the safety and efficacy of radioembolization in patients with unresectable colorectal liver metastases selected as candidates for 90Y resin microspheres. Journal of Gastrointestinal Oncology. 2015; 6: 134–142.
- SIR-Spheres® microspheres (Yttrium-90 Microspheres) Product Information.
Available at: com/us/clinicians/package-insert/.
- Wei A, Greig P, Grant D, et al. Survival After Hepatic Resection for Colorectal Metastases: A 10-Year Experience. Annals of Surgical Oncology. 2006; 13:668-676.
- Portier G, Elias D, Bouche O, et al. Multicenter Randomized Trial of Adjuvant Fluorouracil and Folinic Acid Compared With Surgery Alone After Resection of Colorectal Liver Metastases: FFCD ACHBTH AURC 9002 Trial. Journal of Clinical Oncology. 2006; 24: 4976-4982.
- Capussotti L, Muratore A, Mulas MM, Massucco P, Aglietta M. Neoadjuvant Chemotherapy and Resection for Initially Irresectable Colorectal Liver Metastases. British Journal of Surgery. 2006;93:1001-1006.